| NPI | 1568454759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: IA 27598) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA 27598) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2007-12-04 |